Factors predicting the operative difficulty in Laparoscopic cholecystectomy: An observational study.
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 9954-9961
AbstractBackground: Laparoscopic cholecystectomy is minimally invasive surgery done for
removal of diseased gall bladder and considered as gold standard. It is the commonest
general surgical procedures done worldwide.
Methodology: An observational study done in Hind Institute of medical Sciences,
Barabanki. from June 2017 to June 2021 during which patients admitted with the plan
of laparoscopic cholecystectomy were preoperatively evaluated clinically, biochemically
and radiologically. LC was performed by standard 4 port technique was under GA by
qualified surgeon and well-trained team. Surgery was categorised into easy, difficult
and very difficult depending on the duration of surgery. Preoperative factors were then
analysed and compared with the operative difficulty.
Result: A total of 300 patient underwent LC in which 71.7% were females. Mean age of
patients was 41.36±13.68 years with 31.3% patients between 41-49 years. Recurrent
abdominal pain was observed in 38.3% and 4.3% patient had history of biliary
pancreatitis. Ultrasonologically, single stone was observed in 62% whereas thickened
GB wall was observed in 33%. Serum ALP was elevated in 2.3 % whereas 2.7% had
leucocytosis. Operative ease was encountered in 40% consuming < 60 minutes, whereas
56.7% was difficult (60-120 mins) and 3.3 % were very difficult (>120 mins).
Conversion rate was 1.65%, all from very difficult category. Age 40-49 years, solitary
GB calculus, GB wall thickness > 4mm, leucocytosis and history of pancreatitis has
statistically significant correlation with difficult cholecystectomy but no such association
was observed with gender, elevated serum ALP and comorbidities.
Conclusion: Difficult LC was observed in 60% patients. Age between 41-50 years,
solitary GB calculus and thickened GB wall (>4mm) with a attack of pancreatitis can be
considered as predictor for difficult cholecystectomy.
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